Advising On All Levels

If infectious disease experts at the Yale School of Public Health ever needed a compelling reason to step out of their labs or away from their research and share their expertise with the wider world, they have one now.

“We are in a pandemic,” said Albert Ko, M.D., the Raj and Indra Nooyi Professor of Public Health. “It’s important that we provide service and contribute to the response. It is a strong motivating force that resonates with all of our colleagues at the school.”

Ko is among many Yale School of Public Health researchers who answered the call to lend their specialized knowledge to state, national and even international efforts to stop the spread of COVID-19 and help guide vaccine policy and strategy. He was tapped by Connecticut Gov. Ned Lamont to co-chair the Reopen Connecticut Advisory Group and serve on the state’s Vaccine Advisory Group science subcommittee. “It is critical in a pandemic to take the innovation and rigor of academics and translate it into public policy and action,” said Ko.

The Vaccine Advisory Group was convened in October 2020—before any vaccine had received even emergency use authorization by the Food and Drug Administration (FDA)—to help the state government navigate the distribution of any COVID-19 vaccines when they became available. In addition to turning to public health experts and health care professionals, Lamont tapped state lawmakers and representatives from private industry to get their perspectives on how to shape the state’s vaccination effort.

“It is always a tricky process,” Ko said. “Public health is a key cornerstone of society but is one piece in overall well-being. All considerations have to be balanced, and that’s the job of elected officials. There are often trade-offs. Safe and effective vaccines are different. That is a win-win situation for everybody and on all fronts.”

Yet for many, the COVID-19 vaccine was not viewed as a win-win. It was becoming clear, when the advisory group convened, that political challenges might interfere with public acceptance of the vaccine. “Because you have sound evidence or good expertise doesn’t necessarily mean you are going to make good policy,” Ko said.

Connecticut was among many states that understood the necessity of forming their own groups to guide vaccine policy, in the absence of a unified strategy from the federal government. Additionally, because the COVID-19 vaccine was being administered to the public with only an emergency use authorization, rather than full approval of the FDA, the group provided an extra layer of guidance and protection.

Vaccinologist Saad Omer, Ph.D., M.P.H., director of the Yale Institute for Global Health and Susan Dwight Bliss Professor of Epidemiology, also participates in national and international committees that were convened to guide policy, including the National Academies of Sciences, Engineering and Medicine committee aimed at driving an equitable distribution of COVID-19 vaccines, and the World Health Organization’s Strategic Advisory Group of Experts on Immunization’s COVID-focused working group.

“Democracies at their best, at any level—state, federal or local—empower those who contribute to a robust marketplace of ideas. It is not the technocrat closest to the dictator who is influencing policy,” Omer said. “Those who contribute these ideas have the responsibility to present the best possible evidence, without partisan politics, to the policymakers.”

The state advisory group was split into three subcommittees: one focused on communication to the public, one on allocation of the vaccines once they were received, and a scientific subcommittee to examine the therapeutic efficacy of the vaccines.

“Our group was created at a time when there were concerns, frankly, about the integrity of federal decision-making process,” said Jason L. Schwartz, Ph.D., associate professor in the Department of Health Policy and Management and the chair of the advisory group’s subcommittee on science.

He said the group examined the data provided by the vaccine manufacturers so the vaccines could be distributed to the public as quickly—and safely—as possible, while also withstanding political pressure to rush a vaccine to market ahead of the November presidential election without adequate safeguards.

“This was made easier by being able to see the FDA’s detailed analysis of the data on safety and efficacy and by the timing of the request for emergency use authorization: after the presidential election when the political pressure to approve vaccine would be less of a factor,” said James Hadler, M.D., M.P.H. ’82, a senior epidemiologist with the Emerging Infections Program at the Yale School of Public Health and a clinical professor at the Yale School of Medicine. From 1984 to 2008, he was Connecticut’s state epidemiologist.

The state also needed to ensure that any vaccine would be distributed as equitably among state residents as possible, and that it reached all communities, particularly marginalized and vulnerable groups. A member of the allocation subcommittee, Tekisha Dwan Everette, Ph.D., an adjunct assistant professor at the time of her appointment (and now a student in the Advanced Professional M.P.H. Program), emphasized measuring the disproportionate impact of COVID-19 on Black and brown communities to ensure vaccine access for the most marginalized groups. Everette said she recognizes that the data will likely show what is already known: that the inequities observed among racial minorities before the pandemic will be the same observed throughout the pandemic if left unaddressed.

The advisory group’s effort peaked over the winter, when vaccines were becoming available for broadening use, and the group was unanimous in its recommendation for each of the three available vaccines, Moderna, Pfizer, and Johnson and Johnson, to be administered to Connecticut residents. In the spring, as the vaccine began to reach wide swaths of Connecticut residents, the advisory group’s work came to an end. As of the summer of 2021, Connecticut had one of the highest rates of vaccination of any U.S. state, with more than 63% of eligible residents vaccinated, compared with the national rate of 50%.

“Overall, I think Connecticut has fared very well in its vaccine effort,” Hadler said. “We’d like to have even higher vaccination levels than we have, and we’re continuing our efforts to vaccinate as many as possible.”